Ali Şefik Sanaç

Management of strabismus in nanophthalmic patients: A long-term follow-up report

PURPOSE The purpose of this study is to identify the characteristics of strabismus that coexist with nanophthalmos and to report the results of strabismus surgery performed on these small eyes. DESIGN Retrospective, consecutive, noncomparative interventional case series. PARTICIPANTS Fifteen bilateral nanophthalmic patients, of whom five underwent horizontal muscle surgery, were included in this study. METHODS Chart review. The clinical examination included visual acuity assessments using the linear Snellen and the Lea charts, slit-lamp and fundus examinations, intraocular pressure, and axial length measurements. The orthoptic examination consisted of measurements of ocular deviations using the prism cover test with an accommodative target at both near and distance with and without refractive correction, assessment of ocular motility with ductions and versions, binocularity with Worths four-dot test, and the Titmus test. Amblyopia was treated with part-time occlusion. Surgery for the correction of esotropia included bilateral medial rectus recessions or recess-resect procedures. MAIN OUTCOME MEASURES Magnitude of strabismic deviation, best-corrected visual acuity, and the level of binocular vision achieved were monitored. RESULTS The average age of enrollment in the study was 4.7 (range, 1-12) years. The patients were followed for an average of 7.0 (range, 4-14) years. The mean axial length was determined as 18.4 mm (range, 15.5-20.7). The mean refractive error in spherical equivalents was measured as +9.9 and ranged between +4.0 and +15.0 diopters. Five patients (33%) had nonaccommodative esotropia, four (27%) had partially refractive esotropia, four (27%) had microesotropia, and two (13%) had exotropia. Five patients, all having nonaccommodative esotropia, underwent surgery for the correction of ocular misalignment. Diminishing the surgical dose in these small eyes resulted in undercorrections. Despite patching, 3 patients (20%) had unilateral and 12 patients (80%) had bilateral amblyopia at the conclusion of the study. CONCLUSIONS Strabismus in nanophthalmos usually manifests as nonaccommodative and partially refractive esotropia. Medial rectus recession should be applied with care to prevent adduction deficit and convergence insufficiency. Otherwise, there seems to be no need for decreasing the surgical dose with regard to the smaller axial length. Amblyopia tends to be persistent in these patients.

Sequential presentation of bilateral Brown syndrome

Brown syndrome, characterized by a limitation of elevation in adduction and positive forced duction testing, is usually unilateral but occurs bilaterally in 10% of all cases. It may present as a congenital condition in one eye and develop in the other eye with no apparent cause. We present a case of bilateral Brown syndrome in which the right eye became involved within 1 year of surgery on the left eye for congenital Brown syndrome.

Effect of Visual Acuity on the Surgical Outcomes of Secondary Sensory Strabismus.

Objectives: To investigate the outcomes of secondary sensory strabismus surgery and to discuss the effect of visual acuity on success. Materials and Methods: The medical records of patients with sensory strabismus who underwent recession-resection on the eye with vision loss were reviewed. Only patients with visual acuity of ≤0.2 in the operated eye were enrolled. Data including age at surgery, visual acuity, etiology of vision loss, preoperative and postoperative deviations, follow-up duration, and surgical outcomes were recorded. Success was defined as a final deviation of ≤10 prism diopters (PD). To evaluate the effect of visual acuity on postoperative success, patients were grouped as follows according to the visual acuity of the operated eye: group 1, visual acuity <0.05; group 2, 0.05-0.1; and group 3, 0.125-0.2. Results: Ten females and 14 males met the inclusion criteria. The mean age at surgery was 21 years (range, 6 to 56 years). The mean preoperative deviation angle was 52.7 PD (range, 20 to 80 PD). Age at surgery, preoperative deviation and follow-up time were similar in patients with esotropia (n=7) and exotropia (n=17) (p>0.05 for all). The success rate was 62.5% at short-term and 42.1% at long-term follow-up. There was no statistically significant difference in short-term success rate among visual acuity subgroups (p=0.331), whereas the difference was statistically significant at long-term follow-up (p=0.002). The long-term success rate was higher in group 3 compared to groups 1 and 2. Conclusion: Better visual acuity seems to be a potential predictor for higher long-term success after strabismus surgery in patients with sensory strabismus.

Bilateral choroidal detachment following cataract surgery in a 40-day-old infant

We report a case of bilateral choroidal detachment that occurred shortly after uneventful bilateral lensectomy and anterior vitrectomy. B-scan ultrasonography showed severe choroidal detachment in the right eye accompanied by limited detachment of the overlying retina and mild choroidal effusion in the left eye. Two bilateral peribulbar injections of corticosteroid 5 days apart resulted in complete resolution of the choroidal effusion in each eye.

Ocular Causes of Abnormal Head Position: Strabismus Clinic Data

Objectives: To determine the most common ocular causes and types of abnormal head position (AHP) and describe their clinical features. Materials and Methods: Patients with AHP who had been followed in the strabismus unit were retrospectively reviewed. Demographic features and orthoptic characteristics were recorded. Results: A total of 163 patients including 61 women (37.4%) and 102 men (62.6%), with a mean age of 19.9±18.3 were recruited. The most common causes of AHP were determined as fourth cranial nerve palsy (33.7%), Duane retraction syndrome (21.5%), sixth cranial nerve palsy (11%), nystagmus blockage syndrome (9.8%) and Brown syndrome (6.7%). Other less frequent causes were A-V pattern strabismus, comitant strabismus, thyroid orbitopathy and third cranial nerve palsy. The most common types of AHP were head tilt (45.4%) and face turn (36.8%). Out of 142 patients whose visual acuity could be evaluated, 28.2% had amblyopia. The frequency of amblyopia varied depending on the diagnosis (p<0.001), while there was no relation between amblyopia and different types of AHP (p=0.497). Stereopsis and fusion could be tested in 128 patients and 43.8% of them had stereopsis and fusion. The presence of stereopsis and fusion was found to be related with the diagnosis (p=0.001), whereas it was not related with the types of AHP (p=0.580). The presence of amblyopia was not significantly associated with fusion (p=1.000) or stereopsis (p=0.602). Conclusion: There are many ocular pathologies that cause AHP. Patients with similar diagnoses may have different types of AHP. Patients may have amblyopia and impaired binocularity despite AHP. Therefore, all patients with AHP should be examined in detail and these points should be considered in the treatment plan.

Peripapillary Staphyloma in a Child with Intermittent Exotropia

Peripapillary staphyloma is an extremely rare non-hereditary congenital anomaly in which an excavation surrounds the relatively normal optic disk [1]. The aetiology of peripapillary staphyloma is unknown. It is thought to arise as a sequel to disturbance of scleral development at about 20 weeks gestation, perhaps arising as a consequence of the new development of intraocular pressure causing scleral herniation at this stage of development [2,3]. It is generally occurs in isolation [3,4]. Peripapillary staphyloma is generally unilateral, but a few cases of bilateral staphylomas have been reported [1,5-7]. Patients with peripapillary staphyloma are generally emmetropic or slightly myopic and their visual acuity usually is markedly reduced in the affected eye [5,8]. Occlusion therapy may rarely provides visual improvement [4]. Retinal detachment associated with peripapillary staphyloma has been published in a few reports [4,6,8,9]. We document the clinical features of peripapillary staphyloma in a 3-year-old girl with intermittent exotropia.

Geniş Bir Konkomitan Şaşılık Ailesinde Gen Lokalizasyonunun Saptanması

Ya z›fl ma Ad re si/Ad dress for Cor res pon den ce: Dr. Kadriye Erkan Turan, Hacettepe Üniversitesi Tıp Fakültesi, Göz Hastalıkları Anabilim Dalı, Ankara, Türkiye Tel.: +90 312 305 17 77 E-pos ta: kadriyerkan@gmail.com Ge lifl Ta ri hi/Re cei ved: 05.03.2013 Ka bul Ta ri hi/Ac cep ted: 17.06.2013 Kadriye Erkan Turan, Emin Cumhur Şener, Ali Şefik Sanaç Hacettepe Üniversitesi Tıp Fakültesi, Göz Hastalıkları Anabilim Dalı, Ankara, Türkiye Öz gün Arafl t›r ma / Ori gi nal Ar tic le